A research team from the BC-CfE, led by Kalysha Closson, Research Coordinator, Epidemiology and Population Health, recently studied the HIV prevention behaviour, including condom use, partner communication and refusal of unwanted sex, of adolescents in Soweto, South Africa. The study focused on the link between sexual self-efficacy (SSE) – one’s confidence or perceived control over sexual behaviour – and HIV risk.

“A reduction in condom use has been observed in South Africa, which has the highest absolute number of people living with HIV in the world,” says Closson. “This is a concerning development, particularly for young women in sub-Saharan Africa aged 15–24, who face HIV incidence rates up to four times higher than those of men in the same age group, which accounts for an average of 2,000 new infections every week in the country.

There is inconclusive evidence regarding SSE and condom use among adolescents within HIV hyper-endemic settings such as South Africa.

Closson and her colleagues examined 63 studies among youth in sub-Saharan Africa and found that young men may have higher confidence to use condoms compared to young women, and that high SSE in cross-sectional studies may be associated with consistent condom use reports. This was not found to be true for young women, particularly when reported within intervention studies aimed at increasing condom use or reducing HIV risk behaviour.

“The findings from these studies highlight that individual-level efforts aimed at improving young women’s confidence in their ability to reduce their risk for HIV through increased condom use and refusal of unwanted sex are important,” says Closson. “However, in order for effective behaviour change to occur, efforts need to examine and focus on socio-structural barriers to sexual agency and decision making that prevent young women from translating perceived control into action.”

Moreover, there is a clear need for diversity in HIV prevention methods that move beyond male-controlled condoms, according to Closson. Efforts in rolling out new prevention methods, such as pre-exposure prophylactics (in ring, gel and pill formation) need to continue to acknowledge the socio-structural and relational dynamics of sexual decision-making.

Researchers believe future research should examine motivations behind sexual initiation, intimacy, and experiences of intimate partner violence and controlling behaviour. Particularly among adolescent women within age-disparate partnerships who report high sexual self-efficacy, but don’t see it translate into consistent condom use.